The N-brace trial: Does arm position during immobilisation of proximal humerus fractures influence outcome - A preliminary study.

Background: Traditional initial management of proximal humerus fractures (PHF) involves arm immobilisation in a simple sling (SS) in an internally rotated position. We believe this risks fracture displacement and imbalance of soft tissues, encouraging malunion and stiffness. A neutral-rotation brace (NRB) maintains an arm position which may prevent this, leading to quicker and superior recovery. Methods: We randomised patients with two- to four-part PHF into 4 weeks of immobilisation with either a SS or NRB, independent of surgery. Range of motion (ROM), subjective shoulder value (SSV), DASH, Constant-Murley (CMS) and Oxford Shoulder (OSS) scores were assessed at 6-weeks, 3-months and 1-year post-injury. Results: The SS group included 11 patients vs 9 in the NRB group. At final follow-up, the SS and NRB groups had mean DASH scores of 42 vs 35, OSS 42 vs 46, CMS 71 vs 86, SSV 84% vs 92%, respectively. ROM was superior with the NRB (elevation 159°, ER 47° and IR score 8 vs 140°, 37° and 7 with SS). Conclusions: Despite being a small series, our results demonstrate a trend towards NRB providing better outcomes. This feasibility study supports the need for a larger multi-centre randomised controlled trial comparing these immobilisation methods for PHF.

Short- to mid-term results of ulna head replacement as both a primary and revision implant.

We present the results of short- to medium-term follow-up of 10 patients following ulna head replacement. The mean age of patients was 63.2 years (range 48-81 years), with the mean duration of follow-up being 48 months (12-88 months). The indications for the procedure were primary osteoarthritis (n = 3), post-traumatic osteoarthritis (n = 4), failed Darrach's procedure (n = 2) and rheumatoid arthritis (n = 1). Two patients required revision (20%), one for gross aseptic loosening of the stem and another for an initially oversized head. At final follow-up, the satisfactory rate was 90%. The mean VAS score was 2.4 (range 0-8). The average DASH score was 37 (range 0-72.5). Our study suggests that ulna head replacement can give satisfactory forearm function; however, concerns exist regarding bone resorption and tapering around the prosthesis, which may affect the long-term performance of the prosthesis. LEVEL OF EVIDENCE: IV.

Rotator cuff repair failure in vivo: a radiostereometric measurement study.

BACKGROUND: The prevalence of failure among repairs of the rotator cuff is well known, but very few objective data exist regarding either the scale or timing of this complication. The aim of this study was to use a previously validated modified technique of roentgen stereophotogrammetric analysis to monitor the behavior of the rotator cuff after repair to establish at what point failure may occur. MATERIALS AND METHODS: A series of 10 patients had metal beads and wire sutures embedded into the humeral greater tuberosity and supraspinatus tendon, respectively, during open cuff repair procedures. Roentgen stereophotogrammetric analysis imaging of the repaired rotator cuffs was performed at set intervals during the first year after surgery. RESULTS: The mean distance between the tendon and bone markers did not increase significantly between the time of surgery and 3 to 4 weeks. There was then a significant increase of 7.0 mm in the distance between the tendon and bone markers, with the largest increase occurring between 3 to 4 weeks and 12 to 14 weeks after surgery, as well as a further small but significant increase of 1.7 mm between 12 to 14 weeks and 1 year. These results were compared with clinical examination and ultrasound findings. CONCLUSION: Most tendon marker movement was seen during the most intensive period of physiotherapy, in the second and third months after surgery. Significantly more movement was seen in the tendon markers of those patients in whom the repair failed.